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Journal articleCharani E, Gharbi M, Moore LSP, et al., 2017,
The effect of adding a mobile health intervention to a multimodal antimicrobial stewardship programme across three teaching hospitals – an interrupted time series study
, Journal of Antimicrobial Chemotherapy, Vol: 72, Pages: 1825-1831, ISSN: 1460-2091Objectives To evaluate the impact of adding a mobile health (mHealth) decision support system for antibiotic prescribing to an established antimicrobial stewardship programme (ASP). Methods In August 2011, the antimicrobial prescribing policy was converted into a mobile application (app). A segmented regression analysis of interrupted time series was used to assess the impact of the app on prescribing indicators using data (2008-2014) from a biannual point prevalence study (PPS) in medicine and surgery wards. There were six data points pre and six data points post-implementation. Results There was an increase in compliance with policy (e.g. compliance with empirical therapy or expert advice) in medicine (6.48%, CI -1.25—14.20) and surgery (6.63%, CI 0.15—13.10) in the implementation period, with a significant sudden change in level in surgery (p<0.05). There was an increase, though not significant, in medicine (15.20%, CI 17.81—48.22) and surgery (35.97%, -3.72—75.66) in the percentage of prescriptions that had a stop/review date documented. The documentation of indication decreased in both medicine (-16.25%, CI -42.52—10.01) and surgery (-14.62%, CI -42.88—13.63).Conclusion Introducing the ‘app’ to an existing ASP had a significant impact on the compliance to policy in surgery, and a positive but not significant effect on documentation of stop/review date in both specialties. The negative effect on the third indicator may have been due to existing ASP efforts. The broader value of providing an antimicrobial policy on a digital platform e.g. the reach and access to the policy, should be measured using indicators more sensitive to mHealth interventions.
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Journal articleHolmes AH, Boyd SE, Moore LSP, et al., 2017,
Obtaining antibiotics online from within the UK: a cross-sectional study
, Journal of Antimicrobial Chemotherapy, ISSN: 1460-2091 -
Journal articleRawson T, Moore L, Tivey A, et al., 2017,
Behaviour change interventions to influence antimicrobial prescribing: a cross-sectional analysis of reports from UK state-of-the-art scientific conferences
, Antimicrobial Resistance and Infection Control, Vol: 6, ISSN: 2047-2994BackgroundTo improve the quality of antimicrobial stewardship (AMS) interventions the application of behavioural sciences supported by multidisciplinary collaboration has been recommended. We analysed major UK scientific research conferences to investigate AMS behaviour change intervention reporting. MethodsLeading UK 2015 scientific conference abstracts for 30 clinical specialties were identified and interrogated. All AMS and/or antimicrobial resistance(AMR) abstracts were identified using validated search criteria. Abstracts were independently reviewed by four researchers with reported behavioural interventions classified using a behaviour change taxonomy. ResultsConferences ran for 110 days with >57,000 delegates. 311/12,313(2.5%) AMS-AMR abstracts (oral and poster) were identified. 118/311(40%) were presented at the UK’s infectious diseases/microbiology conference. 56/311(18%) AMS-AMR abstracts described behaviour change interventions. These were identified across 12/30(40%) conferences. The commonest abstract reporting behaviour change interventions were quality improvement projects [44/56 (79%)]. In total 71 unique behaviour change functions were identified. Policy categories; “guidelines” (16/71) and “service provision” (11/71) were the most frequently reported. Intervention functions; “education” (6/71), “persuasion” (7/71), and “enablement” (9/71) were also common. Only infection and primary care conferences reported studies that contained multiple behaviour change interventions. The remaining 10 specialties tended to report a narrow range of interventions focusing on “guidelines” and “enablement”. ConclusionDespite the benefits of behaviour change interventions on antimicrobial prescribing, very few AMS-AMR studies reported implementing them in 2015. AMS interventions must focus on promoting behaviour change towards antimicrobial prescribing. Greater focus must b
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Journal articleZingg W, Hopkins S, Gayet-Ageron A, et al., 2017,
Health-care-associated infections in neonates, children, and adolescents: an analysis of paediatric data from the European Centre for Disease Prevention and Control point-prevalence survey
, LANCET INFECTIOUS DISEASES, Vol: 17, Pages: 381-389, ISSN: 1473-3099 -
Book chapterCastro Sanchez EM, Holmes A, Pittet D, 2017,
Chapter 28: Institutional safety climate.
, Hand Hygiene: A Handbook for Medical Professionals, Editors: Wiley-Blackwell -
Journal articleIwami M, Ahmad R, Castro Sanchez E, et al., 2017,
Capacity of English NHS hospitals to monitor quality in infection prevention and control using a new European framework: a multi-level qualitative analysis.
, BMJ Open, Vol: 7, ISSN: 2044-6055Objective: (1) To assess the extent to which current English national regulations/policies/guidelines and local hospital practices align with indicators suggested by a European review of effective strategies for infection prevention and control (IPC); (2) to examine the capacity of local hospitals to report on the indicators and current use of data to inform IPC management and practice. Design: A national and local-level analysis of the 27 indicators was conducted. At the national level, documentary review of regulations/policies/guidelines was conducted. At the local level: a) documentary review of 14 hospitals to determine the capacity to report on performance; b) qualitative interviews with three senior managers from five hospitals and direct observation of hospital wards to identify gaps in use of these indicators to improve IPC management and practice.Setting: Two acute English National Health Service (NHS) trusts and one NHS foundation trust (14 hospitals).Participants: Three senior managers from five hospitals for qualitative interviews.Primary and secondary outcome measures: As primary outcome measures, a ‘Red-Amber-Green’ (RAG) rating was developed reflecting how well the indicators were included in national documents or their availability at local organisational level. The current use of the indicators to inform IPC management and practice was also assessed. Secondary outcome measure includes the assessment of gaps across national and local levels by comparing the RAG rating results.ResultsNational regulations/policies/guidelines largely cover the suggested European indicators. The ability of individual hospitals to report some of the indicators at ward level varies across staff groups, which may mask required improvements. A reactive use of staffing-related indicators was observed rather than the suggested prospective strategic approach for IPC management.ConclusionsFor effective patient safety and infection prevention in English hospitals, ro
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Journal articleRawson T, Charani E, Moore L, et al., 2016,
Vancomycin therapy in secondary care; investigating factors that impact therapeutic target attainment
, Journal of Infection, Vol: 74, Pages: 320-324, ISSN: 1532-2742 -
Journal articleJauneikaite E, Khan-Orakzai Z, Kapatai G, et al., 2016,
Nosocomial outbreak of drug resistant Streptococcus pneumoniae serotype 9V in an adult respiratory medicine ward
, Journal of Clinical Microbiology, Vol: 55, Pages: 776-782, ISSN: 1098-660XStreptococcus pneumoniae infections arising in hospitalized patients are often assumed to be sporadic, and linked to community carriage. Here, whole genome sequencing was used to demonstrate nosocomial acquisition of antimicrobially-resistant ST156-9V S. pneumoniae in 3 respiratory patients resulting in two bacteremias and one lower respiratory tract infection. Two of the cases arose in patients who had recently been discharged from hospital and were re-admitted from the community. Nosocomial spread was suspected solely because of a highly unusual resistance pattern and case presentations within 24h of one another. The outbreak highlights a potential for rapid transmission and short incubation period in the respiratory ward setting.
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Journal articleRawson T, Charani E, Moore L, et al., 2016,
Mapping the decision pathways of acute infection management in secondary care among UK medical physicians: a qualitative study
, BMC Medicine, Vol: 14, ISSN: 1741-7015BackgroundThe inappropriate use of antimicrobials drives antimicrobial resistance. We conducted a study to map physician decision making processes for acute infection management in secondary care to identify potential targets for quality improvement interventions.MethodsNewly qualified to Consultant level physicians participated in semi-structured interviews. Interviews were audio recorded and transcribed verbatim for analysis using NVIVO11.0 software. Grounded theory methodology was applied. Analytical categories were created using constant comparison approach to the data and participants were recruited to the study until thematic saturation was reached. ResultsTwenty physicians were interviewed. The decision pathway for the management of acute infections follows a Bayesian-like step-wise approach, with information processed and systematically added to prior assumptions to guide management. The main emerging themes identified as determinants of the decision making of individual physicians were; (i) perceptions of providing “optimal” care for the patient with infection by providing rapid and often intravenous therapy; (ii) perceptions that stopping/de-escalating therapy was a senior doctor decision with junior trainees not expected to contribute; (iii) expectation of interactions with local guidelines and microbiology service advice. Feedback on review of junior doctor prescribing decisions was often lacking, causing frustration and confusion on appropriate practice within this cohort. ConclusionInterventions to improve infection management must incorporate mechanisms to promote distribution of responsibility for decisions made. The disparity between expectations of prescribers to start but not review/stop therapy requires addressing urgently with mechanisms to improve communication and feedback to junior prescribers to facilitate their continued development as prudent antimicrobial prescribers.
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Journal articleVila-Candel R, Navarro-Illana P, Navarro-Illana E, et al., 2016,
Determinants of seasonal influenza vaccination in pregnant women. A cross-sectional study in Valencia, Spain
, BMC Infectious Diseases, Vol: 16, ISSN: 1471-2334BackgroundIn most countries the coverage of seasonal influenza vaccination in pregnant women is low. We investigated the acceptance, reasons for rejection and professional involvement related to vaccine information in pregnant women in Valencia, Spain.MethodsObservational retrospective study in 200 pregnant women, 100 vaccinated and 100 unvaccinated, were interviewed during the 2014/2015 vaccination campaign. Electronic medical records, immunization registry and telephone interviews were used to determine reasons for vaccination and immunization rejection.Results40.5% of pregnant women in the health department were vaccinated. The midwife was identified as source of information for 89% of women. The vaccine was rejected due to low perceptions of risk of influenza infection (23%), lack of information (19%), considering the vaccine as superfluous (16%), close proximity of delivery date (13%) and fear of side effects (12%).ConclusionPregnant women in Spain declined to be vaccinated due to under-estimation of the risk of contracting or being harmed by influenza, and lack of information. Interventions aiming to optimize vaccination coverage should include information addressing the safety and effectiveness of the current vaccine together with improved professional training and motivation.
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